直肠癌患者围术期血液流变学的变化

目的：探讨直肠癌患者麻醉手术期间及术后早期血液流变性的变化。方法：选择ASAⅠ-Ⅱ级行直肠癌根治手术的病人共30例，年龄40-60岁，在麻醉前、麻醉后30min、术毕（麻醉苏醒时）、术后24、48、72h分别采肘静脉血，检测Hηb、Lηb、ESR、Hct、EAI、EDI、ERI等。结果：与麻醉前比较，麻醉期间Hηb、Lηb、ηr、ηp、Hct、ESR、EAI、ERI均降低，其中Hηb、Lηb、ηp、Hct、ESR与麻醉前比较明显降低（P〈0．05或P〈0．01）；术后早期各血液流变学指标逐渐升高：（1）Hηb、Lηb、ηr、ηp、ESR、EAI至术后72h时超出正常值范围；（2）EDI在术后24h-72h明显降低（P〈0．05）。结论：（1）直肠癌患者患者在麻醉手术前存在明显的血液流变性变化，表现为血液粘滞性增高；（2）麻醉手术期间血液流变性指标降低，血液粘度降低；（3）术后早期患者全血还原粘度、红细胞聚集指数、全血粘度等血液流变学指标逐渐升高，红细胞变形指数明显降低，对保持微循环灌注和避免术后早期血栓形成十分不利。

Changes of perioperative hemorheology in patients with colorectal cancer

Objective： To study the changes of hemorheology in colorectal cancer patients during anesthesia and early postoperation. Methods： 30 cases with ASA level Ⅰ to Ⅱ （ the age of 40 to 60 years old, colorectal cancer patients with radical surgery）. At the following time points： preanesthesia, 30min after anesthesia, the end of operation, 24h, 48h, 72h after operation, erythrocyte sedimentation rate （ESR）, hematocrit （Hct）, high shear blood viscosity （Hqb）, low-cut whole blood viscosity （Lqb）, plasma Viscosity （ηp） of the blood in elbow vein were measured. Results： （1） Preanesthesia patient＇ s Hηb, Lηb, ηr, ηp and ESR significantly increased compares with the normal （P〈0. 01）. （2）During anesthesia, the patient＇s Hηb,Lηb,ηr,ηp, Hct, ESR, EAI, ERI decreased, especially, Hηb,Lηb, ηr, ηp, Hct and ESR obviously down-regulated （P〈0. 05, P〈0. 01）. （3） The early postoperative blood rheology indicators gradually increased： Hηb, Lηb, ηr, ηp, ESR and EAI exceed the normal range to post-operation 72h, and from 24h to 72h EDI decreased significantly （P〈0. 05）. Conclusion： （1）Patients with colorectal cancer before operation have a hemorheological change of blood viscosity which is increased markedly. （2）During anesthesia, hemorheology index and blood viscosity are all decreased. （3）Patients in early postoperative whole blood viscosity, red cell aggregation index, whole reduced viscosity and so on hemorheology indicators gradually increased, at other side, erythrocyte deformability index decreased significantly. These changes may be related to early postoperative incision pain and activities limited and it is very adverse to maintain patency microcirculation and avoid early postoperative thrombosis.